USMLE Step 2 CK Practice Examination
Questions and Answers 2025
1. A 25-year-old woman presents with fatigue, pallor, and heavy menstrual
bleeding. Her hemoglobin is 8 g/dL, MCV is 70 fL, and ferritin is low. What is the
most appropriate next step in management?
A) Start oral iron supplementation
B) Order a bone marrow biopsy
C) Administer vitamin B12 injections
D) Schedule a blood transfusion
E) Prescribe corticosteroids
Answer: A) Start oral iron supplementation
Rationale:
The patient has microcytic anemia (low MCV) and low ferritin, which is diagnostic
for iron deficiency anemia. The most appropriate initial management is oral iron
supplementation to replenish iron stores. Bone marrow biopsy is invasive and
unnecessary here. Vitamin B12 treats macrocytic anemia. Blood transfusion is
reserved for severe symptomatic anemia or hemodynamic instability.
Corticosteroids are not indicated.
,2. A 65-year-old man with a history of smoking and hypertension presents with
sudden-onset severe chest pain radiating to his back. Blood pressure is different
between arms. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
E) Pneumothorax
Answer: C) Aortic dissection
Rationale:
Sudden severe chest pain radiating to the back, along with a difference in blood
pressure between arms, is classic for aortic dissection. Smoking and hypertension
are risk factors. MI usually presents with chest pain but not blood pressure
discrepancies. Pulmonary embolism typically causes dyspnea and pleuritic chest
pain. Pericarditis causes chest pain that improves with leaning forward.
Pneumothorax causes sudden unilateral chest pain and dyspnea.
3. A 30-year-old woman presents with tremors, weight loss, heat intolerance,
and palpitations. On exam, she has a diffusely enlarged thyroid and a bruit over
the gland. Which antibody is most likely positive?
A) Anti-thyroperoxidase antibody
B) Anti-thyroglobulin antibody
C) Thyroid-stimulating immunoglobulin
, D) Anti-mitochondrial antibody
E) Anti-double stranded DNA antibody
Answer: C) Thyroid-stimulating immunoglobulin
Rationale:
Graves disease is the most common cause of hyperthyroidism in young women
and is characterized by thyroid-stimulating immunoglobulins that stimulate the
thyroid gland, causing diffuse enlargement and bruit. Anti-thyroperoxidase and
anti-thyroglobulin antibodies are seen in Hashimoto’s thyroiditis. Anti-
mitochondrial antibody is seen in primary biliary cholangitis. Anti-dsDNA is
specific for systemic lupus erythematosus.
4. A 55-year-old man presents with jaundice, pruritus, and elevated alkaline
phosphatase. Anti-mitochondrial antibody is positive. What is the most likely
diagnosis?
A) Primary biliary cholangitis
B) Primary sclerosing cholangitis
C) Viral hepatitis
D) Autoimmune hepatitis
E) Gallstones
Answer: A) Primary biliary cholangitis
Rationale:
Primary biliary cholangitis (PBC) is a chronic autoimmune cholestatic liver disease
characterized by destruction of intrahepatic bile ducts. It commonly affects
Questions and Answers 2025
1. A 25-year-old woman presents with fatigue, pallor, and heavy menstrual
bleeding. Her hemoglobin is 8 g/dL, MCV is 70 fL, and ferritin is low. What is the
most appropriate next step in management?
A) Start oral iron supplementation
B) Order a bone marrow biopsy
C) Administer vitamin B12 injections
D) Schedule a blood transfusion
E) Prescribe corticosteroids
Answer: A) Start oral iron supplementation
Rationale:
The patient has microcytic anemia (low MCV) and low ferritin, which is diagnostic
for iron deficiency anemia. The most appropriate initial management is oral iron
supplementation to replenish iron stores. Bone marrow biopsy is invasive and
unnecessary here. Vitamin B12 treats macrocytic anemia. Blood transfusion is
reserved for severe symptomatic anemia or hemodynamic instability.
Corticosteroids are not indicated.
,2. A 65-year-old man with a history of smoking and hypertension presents with
sudden-onset severe chest pain radiating to his back. Blood pressure is different
between arms. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
E) Pneumothorax
Answer: C) Aortic dissection
Rationale:
Sudden severe chest pain radiating to the back, along with a difference in blood
pressure between arms, is classic for aortic dissection. Smoking and hypertension
are risk factors. MI usually presents with chest pain but not blood pressure
discrepancies. Pulmonary embolism typically causes dyspnea and pleuritic chest
pain. Pericarditis causes chest pain that improves with leaning forward.
Pneumothorax causes sudden unilateral chest pain and dyspnea.
3. A 30-year-old woman presents with tremors, weight loss, heat intolerance,
and palpitations. On exam, she has a diffusely enlarged thyroid and a bruit over
the gland. Which antibody is most likely positive?
A) Anti-thyroperoxidase antibody
B) Anti-thyroglobulin antibody
C) Thyroid-stimulating immunoglobulin
, D) Anti-mitochondrial antibody
E) Anti-double stranded DNA antibody
Answer: C) Thyroid-stimulating immunoglobulin
Rationale:
Graves disease is the most common cause of hyperthyroidism in young women
and is characterized by thyroid-stimulating immunoglobulins that stimulate the
thyroid gland, causing diffuse enlargement and bruit. Anti-thyroperoxidase and
anti-thyroglobulin antibodies are seen in Hashimoto’s thyroiditis. Anti-
mitochondrial antibody is seen in primary biliary cholangitis. Anti-dsDNA is
specific for systemic lupus erythematosus.
4. A 55-year-old man presents with jaundice, pruritus, and elevated alkaline
phosphatase. Anti-mitochondrial antibody is positive. What is the most likely
diagnosis?
A) Primary biliary cholangitis
B) Primary sclerosing cholangitis
C) Viral hepatitis
D) Autoimmune hepatitis
E) Gallstones
Answer: A) Primary biliary cholangitis
Rationale:
Primary biliary cholangitis (PBC) is a chronic autoimmune cholestatic liver disease
characterized by destruction of intrahepatic bile ducts. It commonly affects
